Home health claim submission, built inside your billing operation
Home health claim submission turns admissions, visits and assessments into claims each payer accepts first pass. Our AI agents assemble, check, file and track every claim beside your EMR; our experts set the rules.
Claim assembly and submission, in the order our study ranks the work
- Notice of admission and notice of election generation and filingThe top pick of 169 workflowsWorth it, ready now
- Period and per-diem claim assemblyIn the top 25 of 169 workflowsWorth it, ready now
- Visit-verification-to-claim matchingIn the top 25 of 169 workflowsWorth it, ready now
- Pre-billing editsIn the top half of 169 workflowsWorth it, ready now
- Held-claim and timely-filing queue managementIn the top half of 169 workflowsWorth it, ready now
- Clearinghouse and federal system return handlingIn the top half of 169 workflowsWorth it, ready now
- Adjustment, cancellation and replacement claimsIn the top half of 169 workflowsWorth it, ready now
- Claim status inquiryIn the top half of 169 workflows
- Secondary and tertiary claimsIn the top half of 169 workflows
- Attachment and documentation package preparation for payers and reviewers that require themIn the lower half of 169 workflows
See your own claim workflows on this list and pick where to start.
Talk about your claim workflow
Claim submission leaks money before the payer ever sees the claim
Home health claim submission quietly costs your agency every day: late notices, hand-built claims, holds nobody owns.
Notices filed late
Each late day costs the period a thirtieth of its payment.
Claims rebuilt by hand
Billers assemble each 30-day claim from three screens, and codes drift by payer.
Edits nobody runs first
Claims bounce on edits the clearinghouse never checked, and holds sit unowned.
Notices, assembly, edits and holds, taken over
Four claim submission workflows our AI agents run inside your billing operation, with rules our experts set beside your team.
Notices filed inside the five-day window.
A notice of admission is due within five calendar days of start of care; each late day costs the period a thirtieth. Our AI agents file it from the admission record and track acceptance; our experts take exceptions.
- Filed from the admission record that day
- Acceptance tracked the same day it is filed
- Every exception documented, none missed
Claims that follow each payer's exact billing rules.
Billers rebuild each 30-day claim from three screens, and codes drift by payer. Our AI agents assemble claims from the period ledger, assessment and visit record, applying your payer's conventions from a rule set our experts maintain.
- Claims pulled straight from the ledger.
- Payer conventions applied from a maintained rule set
- Exceptions queued to a named person
Edits that stop the claim before the payer does
Most agencies learn a claim is wrong when the federal system returns it weeks later. Our AI agents run federal and payer edits before each claim leaves, propose a fix for every flag; your staff make the call.
- Edits applied before the claim leaves the agency
- A fix proposed with every flag
- Your staff review and make the call
How an engagement runs
Your agency keeps its EMR, clearinghouse and portals; our AI agents run beside them, and your staff review what they flag.
01You bring one workflow
Your team brings the workflow that bleeds money, its systems and your numbers. Our experts pick the first against our study of 169 home health and hospice workflows.
02Our experts fix the data
Our engineers sit with your billing team, watch the claim workflow as it runs, and fix the data it depends on. The rules come from your operation.
03Our AI agents take the work
Our AI agents go live inside the workflow, reading, checking, filing and routing, every rule visible to your team. Our experts then move to the next workflow.
Each alternative stops where your payer rules begin
Most agencies weigh custom AI against tools already in the shop. For claim submission, each alternative has a strength and a stopping point.
Custom claim submission built around your payers
Our engineers sit inside your billing operation and build claim submission around your payer mix. Our AI agents run the daily work; your staff keep the judgment calls. You keep your EMR and your data.
- Tailored to your payer mix alone.
- Our experts on site with your billing team
- Your agency keeps its EMR and its data
Billing and RCM software
Good at organizing the billing you already do; it usually runs the same steps for every agency, so payer edits stay manual.*
Your EMR's billing module
Good at staying connected to the chart; it usually covers the standard claim path, leaving payer-specific checks on workarounds.*
An outsourced billing company
Good at taking the claim pile off your desk; usually priced per claim, their playbook decides how the work is done.*
* These describe each category's standard offer, leaving vendor specifics aside. Terms vary by contract and by agency.
Pricing follows the workflows, your EMR stays, your staff decide
How is this priced?
Pricing: a base fee plus a variable portion linked to the workflows automated, independent of seats. Your bill tracks the workflows you run.
Do we replace our EMR?
No. Our AI agents work inside the systems you already use: your EMR, your clearinghouse and your payer portals, reading and writing back. Nothing gets switched out.
Who makes the calls?
Your staff do. Our AI agents check, flag and propose; your team reviews what they flag and makes the call. The software makes no clinical decisions.
What does our agency need to have ready?
Less than you would think: sign-in access to your EMR, clearinghouse and portals, and a staff member who knows the workflow. Our experts bring the ranking and start from there.
Claims that go out clean and come back paid
The first conversation covers one claim workflow: where it breaks, what it costs, what our AI agents take over and what your team keeps. Bring no patient data.
Common questions
What are the different types of bill type codes?
Institutional claims carry a type of bill naming the facility and the claim's place in the sequence; the frequency digit marks an adjustment, cancellation or replacement. Our AI agents set both per your payer.
Does Medicare have a timely filing limit?
Yes. Medicare fee-for-service claims must generally be filed no later than 12 months after the date of service, subject to limited exceptions. Our AI agents escalate held claims before the limit.
How to process COB claims?
Coordination-of-benefits claims are secondary claims filed with the primary payer's remittance attached. Our AI agents generate them from the primary remittance once it posts; our experts handle payers that need a person.
What is electronic visit verification (EVV) and how does it work?
Electronic visit verification records the in-home visit, and states must require it for Medicaid personal care and home health services involving an in-home visit. Our AI agents match billed visits to accepted records.
How would you handle a rejected claim?
Rejected claims are classified and corrected right away. Returned claims carry returned-to-provider reason codes; our AI agents read each code, apply the known fixes and route the rest to a person.
What is the purpose of the HIPAA X12 276/277 health care claim status inquiry/response transaction?
The 276/277 transaction is the standard electronic way to ask a payer where a claim stands and get a structured answer. Our AI agents batch these inquiries and work the portals.
How long do we have to submit a corrected claim to Medicare?
Medicare fee-for-service claims must generally be filed no later than 12 months after the date of service, subject to limited exceptions. Corrected claims carry a frequency code our AI agents set.
What is the timely filing limit for Medicare secondary claims?
Medicare fee-for-service claims must generally be filed no later than 12 months after the date of service, subject to limited exceptions. Our AI agents generate secondary claims from the primary remittance when it posts.
The full study, PDF · 636 KB
The winner is the dullest job in the building
Claim editing and cash posting beat every clever idea in the study, and they beat it every single time we re-ran the numbers.